Current Treatment Paradigms for Advanced Melanoma with Brain Metastases

Area of Science:

• Neuro-oncology
• Medical oncology
• Radiation oncology

Background:

• Melanoma brain metastases treatment has evolved significantly.
• Multidisciplinary care is crucial for optimal outcomes.
• Current clinical practice may not align with guidelines, highlighting unresolved issues.

Purpose of the Study:

• To provide practical guidance on managing melanoma brain metastases.
• To address controversies in therapeutic sequencing and modality roles.
• To explore future advancements for personalized treatment approaches.

Main Methods:

• Narrative review of current literature and clinical guidelines.
• Analysis of controversies regarding stereotactic radiosurgery (SRS), systemic therapies, surgery, and whole brain radiotherapy (WBRT).
• Discussion of emerging molecular characterization and personalized medicine strategies.

Main Results:

• Optimal integration of systemic and local treatments is key.
• Uncertainties remain regarding the ideal sequence of SRS and drug administration.
• The roles of surgery and WBRT require further clarification.

Conclusions:

• A multidisciplinary approach is essential for melanoma brain metastases.
• Addressing current therapeutic controversies is necessary.
• Future advancements lie in molecular profiling for personalized, patient-centered care.